KEY FACTS
Terminology
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Acute necroinflammatory disease of gallbladder (GB) secondary to stasis and ischemia, not related to gallstones
Imaging
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GB wall thickening (> 4 mm) with layered/striated wall
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GB distension
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Positive sonographic Murphy sign, which may not be elicited if patient obtunded, unconscious, or sedated
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US 1st line, HIDA scan for indeterminate US
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40% develop complications such as gangrene, perforation, and empyema
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CT for complications
Top Differential Diagnoses
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Acute calculous cholecystitis
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Nonspecific GB wall thickening
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GB mucocele
Pathology
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Combination of increased bile viscosity and wall Ischemia with secondary infection
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Bile cultures positive in up to 78%
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Pathogenesis multifactorial: Critical illness with sepsis, shock, recent surgery, trauma, or burns
Clinical Issues
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0.2-0.4 % of critically ill patients
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Worse prognosis than acute calculous cholecystitis; mortality rate up to 30%
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Acute RUQ pain, fever, sepsis in critically ill patient
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Nonspecific leucocytosis, elevation of liver function tests
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Diagnosis may be challenging in critically ill patient with multiple comorbidities
Scanning Tips
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Look for complications such as perforation and abscess
is shown in a sick patient with a left ventricular assist device. It was not possible to assess the Murphy sign, as the patient was intubated and sedated.
. There were no gallstones, but there was a small amount of pericholecystic fluid 
.
, wall thickening 
, and a pericholecystic collection 
. No gallstones were found.
with intramural edema. There is localized pericholecystic fluid 
with an abscess that is not shown.Related posts:
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